Review of egg-related salmonellosis and reduction strategies in United States, Australia, United Kingdom and New Zealand.

Globally, Salmonella enterica subsp. enterica is one of the most commonly reported causes of foodborne illness in humans. Contaminated food products of animal origin, particularly egg and egg products are frequently implicated in outbreaks of human salmonellosis. Salmonella enteritidis is frequently involved in egg and egg products-associated foodborne outbreaks in the USA and UK. However, in Australia and New Zealand, human infections caused by this serovar occur as a result of infection acquired while overseas travel, with Salmonella typhimurium being a predominant cause of local foodborne outbreaks. In this paper, an overview of Salmonella epidemiology on laying farms, egg-related Salmonella outbreaks in humans, and regulatory practises to control Salmonella across USA, UK, Australia and New Zealand is provided. Considering the estimated production of eggs in the USA, UK, Australia and New Zealand in 2015, the risk of foodborne illness in general is quite low for humans consuming eggs. Salmonella diagnostics, reporting and surveillance systems have improved over the years and will continue to improve in the years to come. However, given the number of different emerging Salmonella serovars a regular review of Salmonella control strategies from farm to fork is required.

Observations on the introduction and dissemination of Salmonella in three previously low prevalence status pig farms in the United Kingdom.

In the United Kingdom a serological Salmonella surveillance scheme was run in pigs up to 2012. Farms that maintained a low seroprevalence (<10%) were recognised as "Platinum" pig farms. The aim of this study was to investigate the occurrence and distribution of Salmonella in three farms (17P, 18P and 46P) that had lost their "Platinum" status. Four visits to each farm were made over a period of 15 months. The sampling was carried out by collecting pooled pen floor faecal swab and environmental samples. All samples were tested for Salmonella by a modification of ISO6579 Annex D, and serovars were determined for all isolates. The Salmonella prevalence peaked in the Summer/Autumn months and all farms were still positive at the end of the study. The overall sample prevalence was higher in farm 17P (46%) and 18P (35%) than 46P (19%). Monophasic S. Typhimurium (mST) represented 77.8% of the Salmonella isolates, mainly from farms 17P and 46P. The mST isolated at the initial visit may have been introduced via other livestock present on farm or introduction into the herd of infected animals. The results of this study suggest that incursion of mST was likely to be the main cause of the loss of "Platinum" status and confirm that mST can persist in pigs and their environment.

Development of Low-Cost Air Quality Stations for Next Generation Monitoring Networks: Calibration and Validation of PM2.5 and PM10 Sensors.

A low-cost air quality station has been developed for real-time monitoring of main atmospheric pollutants. Sensors for CO, CO2, NO2, O3, VOC, PM2.5 and PM10 were integrated on an Arduino Shield compatible board. As concerns PM2.5 and PM10 sensors, the station underwent a laboratory calibration and later a field validation. Laboratory calibration has been carried out at the headquarters of CNR-IBIMET in Florence (Italy) against a TSI DustTrak reference instrument. A MATLAB procedure, implementing advanced mathematical techniques to detect possible complex non-linear relationships between sensor signals and reference data, has been developed and implemented to accomplish the laboratory calibration. Field validation has been performed across a full "heating season" (1 November 2016 to 15 April 2017) by co-locating the station at a road site in Florence where an official fixed air quality station was in operation. Both calibration and validation processes returned fine scores, in most cases better than those achieved for similar systems in the literature. During field validation, in particular, for PM2.5 and PM10 mean biases of 0.036 and 0.598 µg/m³, RMSE of 4.056 and 6.084 µg/m³, and R² of 0.909 and 0.957 were achieved, respectively. Robustness of the developed station, seamless deployed through a five and a half month outdoor campaign without registering sensor failures or drifts, is a further key point.

Occurrence and characterization of mcr-1-harbouring Escherichia coli isolated from pigs in Great Britain from 2013 to 2015.

Objectives: To determine the occurrence of mcr-1 -harbouring Escherichia coli in archived pig material originating in Great Britain (GB) from 2013 to 2015 and characterize mcr-1 plasmids. Methods: Enrichment and selective culture of 387 archived porcine caecal contents and recovery from archive of 1109 E. coli isolates to identify colistin-resistant bacteria by testing for the presence of mcr-1 by PCR and RT-PCR. mcr-1 -harbouring E. coli were characterized by WGS and compared with other available mcr-1 WGS. Results: Using selective isolation following enrichment, the occurrence of mcr-1 E. coli in caeca from healthy pigs at slaughter from unique farms in GB was 0.6% (95% CI 0%-1.5%) in 2015. mcr-1 E. coli were also detected in isolates from two porcine veterinary diagnostic submissions in 2015. All isolates prior to 2015 were negative. WGS analysis of the four mcr-1 -positive E. coli indicated no other antimicrobial resistance (AMR) genes were linked to mcr-1 -plasmid-bearing contigs, despite all harbouring multiple AMR genes. The sequence similarity between mcr-1 -plasmid-bearing contigs identified and those found in GB, Chinese and South African human isolates and Danish, French and Estonian livestock-associated isolates was 90%-99%. Conclusions: mcr-1- harbouring plasmids were diverse, implying transposable elements are involved in mcr-1 transmission in GB. The low number of mcr-1 -positive E. coli isolates identified suggested mcr-1 is currently uncommon in E. coli from pigs within GB. The high sequence similarity between mcr-1 plasmid draft genomes identified in pig E. coli and plasmids found in human and livestock-associated isolates globally requires further investigation to understand the full implications.

Observations on Salmonella contamination of commercial duck farms before and after cleaning and disinfection.

In the European Union, statutory control of Salmonella is in place in the chicken and turkey sectors, but not in the duck sector. In this study, 14 Salmonella-positive duck farms were sampled before and after cleaning and disinfection, and once the houses had been restocked with a new flock. The cleaning and disinfection programmes used were subdivided into two main categories: ones in which a final formaldehyde disinfection step was included (1) and ones in which it was not included (2). Several types of samples were collected during the study, and faecal samples were those more frequently positive (62% of faecal samples were positive for Salmonella in comparison to 2-23% of samples from all the other sample categories) (P < 0.001). Independently of the cleaning and disinfection programme used, there was a statistically significant (P < 0.001) reduction in the percentage of Salmonella-positive samples between before cleaning and disinfection (41.1%) and after cleaning and disinfection (3.1%). After restocking, the number of Salmonella-positive samples increased significantly (P < 0.001), with 65.3% of the samples tested being positive for Salmonella. Farms in which disinfection programme 1 was used were 5.34 times less likely to have samples positive for Salmonella after cleaning and disinfection than farms which implemented programme 2. Formaldehyde acts effectively against Salmonella even in the presence of some residual organic matter. Limited residual contamination on farms after cleaning and disinfection represents a risk of infection for young ducklings, and thorough cleaning and disinfection procedures should be implemented to reduce the carry-over of infection between flocks.

Colistin resistance in Salmonella and Escherichia coli isolates from a pig farm in Great Britain.

OBJECTIVES: The objective of this study was to characterize colistin-resistant bacteria isolated from pigs on a farm in Great Britain following identification of a plasmid-borne colistin resistance mechanism in Escherichia coli from China. METHODS: Phenotypic antimicrobial susceptibility testing was undertaken by broth dilution and WGS was performed to detect the presence of genes encoding resistance and virulence. Transferable colistin resistance was investigated by conjugation. RESULTS: Two E. coli and one Salmonella Typhimurium variant Copenhagen were shown to be MDR, including resistance to colistin, with one E. coli and the Salmonella carrying the mcr-1 gene; all three harboured chromosomal mutations in genes conferring colistin resistance and both E. coli harboured ß-lactamase resistance. The Salmonella mcr-1 plasmid was highly similar to pHNSHP45, from China, while the E. coli mcr-1 plasmid only had the ISApII and mcr-1 genes in common. The frequency of mcr-1 plasmid transfer by conjugation to recipient Enterobacteriaceae from Salmonella was low, lying between 10(-7) and 10(-9) cfu/recipient cfu. We were unable to demonstrate mcr-1 plasmid transfer from the E. coli. Plasmid profiling indicated transfer of multiple plasmids from the Salmonella resulting in some MDR transconjugants. CONCLUSIONS: Identification of the mcr-1 gene in Enterobacteriaceae from pigs confirms its presence in livestock in Great Britain. The results suggest dissemination of resistance through different horizontally transferable elements. The in vitro transfer of multiple plasmids carrying colistin and other resistances from the Salmonella isolate underlines the potential for wider dissemination and recombination.

Estimation of the sensitivity of various environmental sampling methods for detection of Salmonella in duck flocks.

Reports of Salmonella in ducks in the UK currently rely upon voluntary submissions from the industry, and as there is no harmonized statutory monitoring and control programme, it is difficult to compare data from different years in order to evaluate any trends in Salmonella prevalence in relation to sampling methodology. Therefore, the aim of this project was to assess the sensitivity of a selection of environmental sampling methods, including the sampling of faeces, dust and water troughs or bowls for the detection of Salmonella in duck flocks, and a range of sampling methods were applied to 67 duck flocks. Bayesian methods in the absence of a gold standard were used to provide estimates of the sensitivity of each of the sampling methods relative to the within-flock prevalence. There was a large influence of the within-flock prevalence on the sensitivity of all sample types, with sensitivity reducing as the within-flock prevalence reduced. Boot swabs (individual and pool of four), swabs of faecally contaminated areas and whole house hand-held fabric swabs showed the overall highest sensitivity for low-prevalence flocks and are recommended for use to detect Salmonella in duck flocks. The sample type with the highest proportion positive was a pool of four hair nets used as boot swabs, but this was not the most sensitive sample for low-prevalence flocks. All the environmental sampling types (faeces swabs, litter pinches, drag swabs, water trough samples and dust) had higher sensitivity than individual faeces sampling. None of the methods consistently identified all the positive flocks, and at least 10 samples would be required for even the most sensitive method (pool of four boot swabs) to detect a 5% prevalence. The sampling of dust had a low sensitivity and is not recommended for ducks.

Estimation of the impact of vaccination on faecal shedding and organ and egg contamination for Salmonella Enteritidis, Salmonella Typhiumurium and monophasic Salmonella Typhimurium.

Salmonella Enteritidis (SE) and, to a lesser extent, Salmonella Typhimurium (ST) are associated with egg-related outbreaks in people. Recently, monophasic strains of ST (mST; lacking one phase of the flagellar antigen) have been described, and they have officially been classified as variants of ST and thus may contribute to human exposure to contaminated eggs. Currently used vaccination programmes are licensed for use against biphasic variants of ST, and their efficacy against mST has not yet been investigated. In this study, the effectiveness of four vaccination programmes currently in use in the UK poultry industry was evaluated against challenge with one SE strain, one ST strain and two mST strains. A Bayesian model was used to estimate the impact of vaccination on the rate of faecal shedding and on egg contamination. For the majority of vaccine/challenge strain combinations, there was little or no effect of vaccination on the proportion of birds shedding Salmonella for either biphasic or monophasic strains. However, vaccination was effective at reducing egg contamination. A significantly lower proportion of eggshells were positive for the vaccinated birds compared with non-vaccinated birds, including the mST strains (vaccination resulted in a 55% and 21% reduction for the two mST strains). Calculated across all strains, the estimated rate of positive egg contents was lower in vaccinated birds (Bayesian median was 0.13% for vaccinated birds versus 0.27% for non-vaccinated birds). For both vaccinated and unvaccinated birds, there was also an apparent difference in the proportion of positive organs between strains, with the SE strain resulting in a lower proportion of positive organs at post-mortem examination compared with the other strains.

Characterization of the invasiveness of monophasic and aphasic Salmonella Typhimurium strains in 1-day-old and point-of-lay chickens.

Egg-related outbreaks of salmonellosis are a significant health concern. Although Salmonella Enteritidis (SE) is the major egg-associated serotype, Salmonella Typhimurium (ST) can also infect the hen's reproductive tract and contaminate eggs. Recently, monophasic and aphasic variants of ST have been reported with increased frequency in Europe, and the isolation of these variants from laying flocks triggers the same legislative restrictions associated with biphasic ST strains. However, little is known about the colonization, invasiveness and persistence of monophasic and aphasic ST strains in laying hens. In this study, seven groups of 1-day-old and point-of-lay commercial Hy-line chicken layers were separately challenged with four different strains of monophasic ST, one aphasic ST, one biphasic ST and one egg-invasive SE strain. Tissue samples and cloacal swabs (point-of-lay chickens only) were collected at regular intervals post challenge in order to recover the Salmonella challenge strains. In 1-day-old chicks, only the aphasic ST strain and the SE strain were recovered after direct plating, suggesting that the number of salmonellas colonizing the tissues of the chicks infected with the other strains was likely to be low. Interestingly, all of the strains colonized well in the point-of-lay chickens, and there was no statistical difference in the overall number of positive samples or Salmonella counts between the seven strains. Salmonella was recovered from the point-of-lay birds to the end of the study (20 days after challenge). Monophasic and aphasic ST strains colonized point-of-lay birds as efficiently as biphasic ST and SE strains. Further studies are necessary to estimate the invasiveness of these strains in naturally-infected vaccinated laying hens, and to assess the impact of natural infection on egg contamination.

Bayesian evaluation of meat juice ELISA for detecting Salmonella in slaughtered pigs without specifying a cut-off.

BACKGROUND: Consumption of pork and pork products is a major source of human infection with Salmonella. Salmonella is typically subclinical in pigs, making it difficult to identify infected pigs. Therefore, effective surveillance of Salmonella in pigs critically relies on good knowledge on how well the diagnostic tests used perform. A test that has been used in several countries for Salmonella monitoring is serological testing of meat juice using an ELISA (MJ ELISA) to detect antibodies against Salmonella. This MJ ELISA data could be used to estimate infection prevalence and trends. However, as the MJ ELISA output is a sample-to-positive (S/P) ratio, which is a continuous outcome rather than a binary (positive/negative) result, the interpretation of this data depends upon a chosen cut-off. AIM: To apply Bayesian latent class models (BLCMs) to estimate diagnostic accuracy of the MJ ELISA test values in the absence of a gold standard without needing to apply a cut-off. METHODS AND RESULTS: BLCMs were fitted to data from a UK abattoir survey carried out in 2006 in order to estimate the diagnostic accuracy of MJ ELISA with respect to the prevalence of active Salmonella infection. This survey consisted of a MJ ELISA applied in parallel with the bacteriological testing of caecal contents, carcass swabs and lymph nodes (n = 625). A BLCM was also fitted to the same data but with dichotomisation of the MJ ELISA results, in order to compare with the model using continuous outcomes. Estimates were obtained for sensitivity and specificity of the ELISA over a range of S/P values and for the bacteriological tests and were found to be similar between the models using continuous and dichotomous ELISA outcomes. CONCLUSION: The Bayesian method without specifying a cut-off does allow prevalence to be inferred without specifying a cut-off for the ELISA. The study results will be useful for estimating infection prevalence from serological surveillance data.

Significant differences in the caecal bacterial microbiota of red and grey squirrels in Britain.

Introduction. Red squirrel populations have declined in the UK since the introduction of the grey squirrel, due to resource competition and grey squirrels carrying a squirrelpox virus that is fatal to red squirrels.Hypothesis/Gap Statement. It is not known if the gut microbiota of the two species is similar and if this could impact the survival of red squirrels.Aim. The aim of this study was to profile the caecal microbiota of red and grey squirrels obtained opportunistically from a conservation programme in North Wales.Methodology. Bacterial DNA was extracted from ten red and ten grey squirrels and sent for 16S rRNA sequencing. Three samples from red squirrels returned less than 5000 reads, and so were not carried forward for further analyses.Results. Samples taken from the caeca of red squirrels had significantly lower bacterial diversity and a higher percentage of Bacilli bacteria when compared to samples from grey squirrels. When the abundance of bacterial groups across all levels of phylogenetic classifications was compared between the two groups of squirrels, grey squirrels had a higher abundance of bacteria belonging to the families S24-7, RF39 and Rikenellaceae. Escherichia coli with resistance to amoxicillin/clavulanic acid was identified in all samples. Cefotaxime resistance was identified in two samples from grey squirrels along with sulfamethoxazole/trimethoprim in one of these samples.Conclusion. Clear differences between the caecal microbiota of the two species of squirrel were identified, which could potentially impact their overall health and ability to compete for resources.

Hepatitis E virus in pork liver sausage, France.

We investigated viability of hepatitis E virus (HEV) identified in contaminated pork liver sausages obtained from France. HEV replication was demonstrated in 1 of 4 samples by using a 3-dimensional cell culture system. The risk for human infection with HEV by consumption of these sausages should be considered to be high.

Assessment of the anti-Salmonella activity of commercial formulations of organic acid products.

Organic acid products are widely used in the UK poultry industry as feed or water additives. Claims for Salmonella control are made for some of these products, but there are few studies comparing the anti-Salmonella effect of the various products in tests that reflect field application. The present studies examined the effects of 13 commercial blends (four water products and nine feed products) on Salmonella Enteritidis and Typhimurium strains. Initial screening, in nutrient broth, of all products with all strains revealed little variation between strains in respect of maximum inhibitory and bactericidal dilutions of each product. However, between the products there was wide and significant variation in the maximum inhibitory and bactericidal dilutions, spanning a 700-fold range in the case of bactericidal dilutions for feed-associated products. Further tests were performed, examining reductions in inoculated Salmonella numbers in various matrices (water, feed, soiled litter, crop and caecal contents) following the addition of the products at recommended inclusion rates. One product, incorporating formaldehyde in addition to organic acid, was consistently most active in all matrices, exceeding reductions associated with other products by 1 to 3 log units at most time points. Many products showed only modest anti-Salmonella activity, amounting to 0 or 1 log unit above negative controls at many time points, and the most active products were not the same in all matrices. Tap water appeared to enhance the ability of products to reduce Salmonella, in comparison with bottled mineral or river water.

Hepatitis E virus in pork food chain, United Kingdom, 2009-2010.

We investigated contamination by hepatitis E virus (HEV) in the pork production chain in the United Kingdom. We detected HEV in pig liver samples in a slaughterhouse, in surface samples from a processing plant, and in pork sausages and surface samples at point of sale. Our findings provide evidence for possible foodborne transmission of HEV during pork production.

Distribution Drivers of the Alien Butterfly Geranium Bronze (Cacyreus marshalli) in an Alpine Protected Area and Indications for an Effective Management.

Cacyreus marshalli is the only alien butterfly in Europe. It has recently spread in the Gran Paradiso National Park (GPNP), where it could potentially compete with native geranium-consuming butterflies. Our study aimed to (1) assess the main drivers of its distribution, (2) evaluate the potential species distribution in GPNP and (3) predict different scenarios to understand the impact of climate warming and the effect of possible mitigations. Considering different sampling designs (opportunistic and standardised) and different statistical approaches (MaxEnt and N-mixture models), we built up models predicting habitat suitability and egg abundance for the alien species, testing covariates as bioclimatic variables, food plant (Pelargonium spp.) distribution and land cover. A standardised approach resulted in more informative data collection due to the survey design adopted. Opportunistic data could be potentially informative but a major investment in citizen science projects would be needed. Both approaches showed that C. marshalli is associated with its host plant distribution and therefore confined in urban areas. Its expansion is controlled by cold temperatures which, even if the host plant is abundant, constrain the number of eggs. Rising temperatures could lead to an increase in the number of eggs laid, but the halving of Pelargonium spp. populations would mostly mitigate the trend, with a slight countertrend at high elevations.

Efficacy of Five Disinfectant Products Commonly Used in Pig Herds against a Panel of Bacteria Sensitive and Resistant to Selected Antimicrobials.

The growing threat of antimicrobial resistance worldwide has led to an increasing concern in the human, veterinary, and environmental fields, highlighting the need for strategies to effectively control bacterial contamination. Correct biosecurity practices, including the appropriate use of disinfectants, play a crucial role in controlling bacterial contamination. This study aimed to verify whether the recommended concentrations defined according to the Defra General Orders concentration (GO, published by the UK Department for Environment, Food and Rural Affairs' disinfectant-approval scheme) of five commercial disinfectant preparations (peroxygen-based, phenol-based, two halogen-releasing agents, and glutaraldehyde/quaternary ammonium compound-based; disinfectants A to E, respectively) were sufficient to inhibit growth and inactivate selected bacterial strains, including some that carry known phenotypic patterns of multidrug resistance. The effectiveness of each disinfectant was expressed as the minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) values, determined by the broth-microdilution method. The results indicate that the type of disinfectant and its concentration influence the inhibitory and bactericidal efficacy. The glutaraldehyde/quaternary ammonium compound-based (disinfectant D) and chlorocresol-based products (disinfectant B) were the most effective, and the GO concentration was bactericidal in all the strains tested. The efficacy of the other compounds varied, depending on the bacterial species tested. The GO concentrations were at least able to inhibit the bacterial growth in all the products and bacterial strains tested. A greater tolerance to the compounds was observed in the strains of E. coli with multidrug-resistance profiles compared to the strains that were sensitive to the same antimicrobials.

Observations on the distribution and control of Salmonella in commercial broiler hatcheries in Great Britain.

Salmonella can enter hatcheries via contaminated eggs and other breaches of biosecurity. The study examined the prevalence and distribution of Salmonella in commercial hatcheries and assessed the effects of providing advice on Salmonella control. Intensive swab sampling was performed throughout 23 broiler hatcheries in Great Britain (GB). Swabs were cultured using a modified ISO6579:2017 method. After each visit, tailored advice on biosecurity and cleaning and disinfection procedures was provided to the hatchery managers. Repeat sampling was carried out in 10 of the 23 hatcheries. Salmonella prevalence ranged between 0% and 33.5%, with the chick handling areas, hatcher areas, macerator area, tray wash/storage areas, external areas and other waste handling areas being more contaminated than the setter areas. Salmonella Senftenberg and Salmonella 13,23:i:- were the most commonly isolated serovars. There was a reduction in Salmonella prevalence at the second visit in eight out of 10 premises, but prevalence values had increased again in all of the improved hatcheries that were visited a third time. One hatchery harboured a difficult-to-control resident Salmonella 13,23:i:- strain and was visited six times; by the final visit, Salmonella prevalence was 2.3%, reduced from a high of 23.1%. In conclusion, the study found low-level Salmonella contamination in some GB broiler hatcheries, with certain hatcheries being more severely affected. Furthermore, it was shown that Salmonella typically is difficult to eradicate from contaminated hatcheries, but substantial reductions in prevalence are possible with improvements to biosecurity, cleaning and disinfection.

Use of genomics to explore AMR persistence in an outdoor pig farm with low antimicrobial usage.

Food animals may be reservoirs of antimicrobial resistance (AMR) passing through the food chain, but little is known about AMR prevalence in bacteria when selective pressure from antimicrobials is low or absent. We monitored antimicrobial-resistant Escherichia coli over 1 year in a UK outdoor pig farm with low antimicrobial usage (AMU) compared to conventional pig farms in the United Kingdom. Short and selected long-read whole-genome sequencing (WGS) was performed to identify AMR genes, phylogeny and mobile elements in 385 E. coli isolates purified mainly from pig and some seagull faeces. Generally, low levels of antimicrobial-resistant E. coli were present, probably due to low AMU. Those present were likely to be multi-drug resistant (MDR) and belonging to particular Sequence Types (STs) such as ST744, ST88 or ST44, with shared clones (<14 Single Nucleotide Polymorphisms (SNPs) apart) isolated from different time points indicating epidemiological linkage within pigs of different ages, and between pig and the wild bird faeces. Although importance of horizontal transmission of AMR is well established, there was limited evidence of plasmid-mediated dissemination between different STs. Non-conjugable MDR plasmids or large AMR gene-bearing transposons were stably integrated within the chromosome and remained associated with particular STs/clones over the time period sampled. Heavy metal resistance genes were also detected within some genetic elements. This study highlights that although low levels of antimicrobial-resistant E. coli correlates with low AMU, a basal level of MDR E. coli can still persist on farm potentially due to transmission and recycling of particular clones within different pig groups. Environmental factors such as wild birds and heavy metal contaminants may also play important roles in the recycling and dissemination, and hence enabling persistence of MDR E. coli. All such factors need to be considered as any rise in AMU on low usage farms, could in future, result in a significant increase in their AMR burden.

Early balance impairment in Parkinson's Disease: Evidence from Robot-assisted axial rotations.

OBJECTIVE: Early postural instability (PI) is a red flag for the diagnosis of Parkinson's disease (PD). Several patients, however, fall within the first three years of disease, particularly when turning. We investigated whether PD patients, without clinically overt PI, manifest abnormal reactive postural responses to ecological perturbations resembling turning. METHODS: Fifteen healthy subjects and 20 patients without clinically overt PI, under and not under L-Dopa, underwent dynamic posturography during axial rotations around the longitudinal axis, provided by a robotic mechatronic platform. We measured reactive postural responses, including body displacement and reciprocal movements of the head, trunk, and pelvis, by using a network of three wearable inertial sensors. RESULTS: Patients showed higher body displacement of the head, trunk and pelvis, and lower joint movements at the lumbo-sacral junction than controls. Conversely, movements at the cranio-cervical junction were normal in PD. L-Dopa left reactive postural responses unchanged. CONCLUSIONS: Patients with PD without clinically overt PI manifest abnormal reactive postural responses to axial rotations, unresponsive to L-Dopa. The biomechanical model resulting from our experimental approach supports novel pathophysiological hypotheses of abnormal axial rotations in PD. SIGNIFICANCE: PD patients without clinically overt PI present subclinical balance impairment during axial rotations, unresponsive to L-Dopa.